Christopher J. Winfree, MD, FAANS
Department of Neurological Surgery, Columbia University
New York, NY
Pain management in American is currently undergoing a renovation. In the early 2000s, it became apparent that undertreated chronic pain was a huge health care problem. The Affordable Care Act (ACA) commissioned a detailed investigation into the status of pain health care delivery in this country. Once problems were identified by the investigation, some major initiatives were established to correct many of these issues. Neurosurgery is an important stakeholder in this process and is part of the National Pain Foundation’s (NPF) Global Pain Initiative. This effort is aimed at changing the way people with pain are treated — physically and emotionally.
In 2010, the ACA charged the National Academy of Medicine (formerly the Institute of Medicine) to publish a report entitled, “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.” This report detailed the relatively primitive state of pain management health care delivery in the United States. For example, chronic pain is poorly understood, pain education in physicians is poor, and the patients who have chronic pain often get suboptimal care. Rather than just highlighting the problems in pain health care delivery in America, the report specified a number of objectives to improve the state of pain health care delivery in the United States. Targeted research, funding to understand the nature of pain, providing evidence for pain treatments, identifying resources to improve physician education, health care practitioners and other stakeholders as well as patients, and the development of patient advocacy platforms were all part of their recommendations.
The NPF, led by Daniel S. Bennett, MD, is a nonprofit organization whose mission is to transform the way pain is fundamentally understood, assessed, and treated, in line with the National Academy of Medicine’s report. One important concept promoted by the NPF is that pain is actually a collection of diseases like cancer or any other major illnesses. Furthermore, the foundation believes pain is potentially curable given sufficient research and investigation in the clinical and outcome studies. The NPF’s Global Pain Initiative was set up to educate physicians, patients, government, representatives, and stakeholders through the publication of a series of peer-reviewed journal supplements on the current state of pain and treatment.
The Global Pain Initiative is currently producing a series of peer-reviewed publications evaluating the basic science of the pathophysiology of chronic pain as well as the evidence base for its non-surgical and surgical treatments. While this current state of evidence has already been published, the NPF is incorporating the perspectives of patients who suffer from chronic pain. The integration of basic scientists, clinicians, patient advocates and eventually corporate stakeholders will then allow for the most effective identification and appropriate prioritization of the remaining shortcomings in pain health care delivery. Once identified, these problems can be systematically addressed through several different mechanisms, such as:
- Educating lawmakers to create compassionate and effective pain legislation;
- Allocating National Institutes of Health (NIH) research funds to more completely understand pain and its treatments;
- Initiating clinical trials to provide robust evidence for pain therapies; and
- Developing public awareness campaigns to make sure patients and providers are aware of pain conditions and their treatments.
Neurosurgery has always played an important role in pain health care delivery which is why I currently serve as organized neurosurgery’s representative within the Global Pain Initiative. It is important for neurosurgeons to maintain an active role in this process, so we can continue to provide state-of-the-art neurosurgical pain treatments for our patients.
Editor’s Note: During the month of September, we encourage everyone to join the conversation online by using the hashtag #painfacts.